What causes a rotator cuff tear?

The Cycle That Leads to a Rotator Cuff Tear

Your shoulder joint is the most mobile joint in the body, and the main function of the rotator cuff muscles is to keep it functioning properly. This group of four muscles connects your humerus (or arm bone) to its articulation with the tip of the shoulder blade. Their orientation within the joint helps the arm perform complex and demanding maneuvers such as throwing a ball, swinging a tennis racket, and lifting objects onto shelves above your head. Damage to the rotator cuff can come from various mechanisms, causing upper arm pain, pain with specific movement, and loss of strength. One such cause is wear and tear. Picture this:

  • The tendons of the rotator cuff pass through a tunnel within the shoulder complex, created by the clavicle or collarbone, the acromion (or tip of the shoulder), and the ligaments that hold the bones together.
  • When the arm moves repetitively, especially in overhead motions, those tendons can bump against the ceiling of the tunnel and become irritated.
  • That irritation leads to inflammation and swelling of the tendon, a condition called impingement syndrome (literally, a squishing of the tendon as it tries to function in a narrow space).
  • Impingement weakens the tendon, making it less resilient to stress and strain.
  • Fraying or small tears can occur.
  • Then, when the tendon bumps against the ceiling of the tunnel again, it is already a little thicker from the inflammation and prior damage. As a result, the tendon has even less space in which to function and so becomes even more irritated and worn down.
This cycle can continue for years, with the tendons becoming weaker and losing their ability to function properly, or until the tendon finally tears.

Other possible causes of a torn rotator cuff include falling, lifting, and repetitive overhead arm activities, such as swimming, throwing, or playing tennis.

Like any other muscle strain, rotator cuff tears are classified by degree, depending upon the amount of tissue damage present. Some tears can be rehabilitated with physical therapy and medication, while others require surgical repair.

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